1/7. Suprachoroidal septic effusion leading to panophthalmitis following strabismus surgery.We describe a case of endophthalmitis following strabismus surgery. drainage of the suprachoroidal effusion with injection of antibiotics was unsuccessful in salvaging vision. endophthalmitis following strabismus surgery may present with findings simulating a choroidal effusion or hemorrhage. Treating physicians should be alert to signs and symptoms of this severe complication of strabismus surgery in preverbal children.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/7. Avoidance of false-negative blood culture results by rapid detection of pneumococcal antigen.False-negative blood culture results may occur in children with pneumococcal bacteremia due to bacterial autolysis. We describe four patients with pneumococcal bacteremia whose aerobic blood cultures showed partial or complete autolysis of the pneumococci. Pneumococcal antigen, however, was rapidly detected in media from the blood culture bottles, using an agglutination assay. Processing of the media before analysis was necessary to prevent nonspecific agglutination and to allow the detection of a specific reaction. It is important that physicians and laboratory personnel be aware that pneumococci may rapidly autolyze during incubation, yielding false-negative culture results. Antigen detection methods may provide rapid and specific identification of the etiologic agent.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/7. Pneumococcal vaccine and hiv infection: report of a vaccine failure and reappraisal of its value in clinical practice.A clinical failure of pneumococcal vaccine is reported. A 22 year old African woman was given 23-valent pneumococcal vaccine at her initial presentation with hiv infection. She was asymptomatic and had a CD4 lymphocyte count above 500 cells/mm3. Eighteen months later she died of meningitis and septicaemia due to streptococcus pneumoniae type 9 (an antigen included in the 23-valent vaccine). Pneumococcal antibody levels performed on stored blood demonstrated no serological response to the vaccine. This is the first reported case of clinical failure of pneumococcal vaccine in an hiv infected patient who received vaccine whilst at the asymptomatic stage of hiv infection and with relatively intact immune function. The literature pertaining to pneumococcal vaccination in the context of hiv infection was reviewed. Pneumococcal vaccination is recommended for hiv positive patients in the UK by the Departments of health. It is likely that many physicians are not aware of these recommendations or are concerned about the poor efficacy of the vaccine, and it may consequently be underused in clinical practice. But the potential gain to the hiv positive patient is such that the vaccine should be offered to all hiv positive patients as soon as they present for medical care, irrespective of the stage of hiv disease. physicians and patients should be aware that the vaccine is not fully protective and that episodes of sepsis, pneumonia and meningitis could still be pneumococcal in origin and should be treated appropriately. awareness of the substantial risks of pneumococcal disease in hiv infected patients with prompt diagnosis and effective treatment is the most important strategy to decrease morbidity and mortality.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/7. Bacterial meningitis with normal cerebrospinal fluid findings. Report of a case and review of the literature.Bacterial meningitis presenting with normal initial CSF findings is rare and could be confusing to the physicians. Such an entity was observed in this first case report from lebanon on an 8-month-old female febrile infant whose initial CSF studies were normal despite the culture yielding streptococcus pneumoniae. Thus, this case emphasizes the need that physicians should start antimicrobial therapy, pending culture results, whenever bacterial meningitis is clinically suspected, even if initial CSF investigation of cellular, protein, sugar and gram-strain results do not reveal abnormal findings. In addition, repeat lumbar puncture should be considered in all febrile patients having clinical features suggestive of this diagnosis.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
5/7. The impact of bacteraemia on hiv infection. Nine years experience in a large Italian university hospital.The object of this case control study was to evaluate the frequency, the risk factors, the microbiological spectrum and the outcome of 249 cases of bacteraemia observed in 209 hiv-infected patients, most them affected by AIDS. The rate of bacteraemia in the total yearly hiv-related admissions increased from 4% in 1985 to 13% in 1993. The more common aetiological agents of bacteraemia were: staphylococcus aureus (29.7%), non-typhoidal species of salmonella (14.1%), staphylococcus epidermidis (10.9%), streptococcus pneumoniae (8.4%) and pseudomonas aeruginosa (7.6%). A mixed flora was found in 14% of the episodes. multivariate analysis of predisposing factors indicated that a low CD4 T-cell count (<0.2 x 10(9)/l) (P=0.01), use of central venous catheters (CVC) (P=0.01) and neutropenia (polymorphonuclear neutrophils <1.0 x 10(9)/l) (P=0.04) were independent risk factors for the development of bacteraemia. Logistic regression did not reveal any association of bacteraemia with intravenous drug abuse (on univariate analysis P=0.04). The response (31.8%). Recurrences to specific therapy was favourable in 170 episodes (68.2%); death occurred in 79 (31.8%). Recurrences arose in 40 patients, 17 (42.5%) of them died. The outcome of bacteraemia was influenced by a low number of CD4 T-cells (P<0.001) but not of polymorphonuclear cells. Our findings suggest that bacteraemia is a relatively common event in hiv-infected patients, especially under particular conditions (e.g. intravenous drug abuse, use of CVC, neutropenia and a low CD4-T-cell count). It requires special attention from physicians who must recognise and treat the condition promptly at an early stage.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/7. A consideration of the differences between a Janeway's lesion and an Osler's node in infectious endocarditis.Janeway's lesions and Osler's nodes are regarded as excellent clues to the diagnosis of infectious endocarditis; however, very few physicians have actually witnessed these findings, and there is some confusion in distingushing between the two. This article concerns a patient with infectious endocarditis due to Diplococcus pneumoniae, who had tender vesicular lesions thought to be Osler's nodes and a nontender erythematous nodule on the foot compatible with a Janeway's lesion. The original comments by William Osler and Edward Janeway are presented, and the literature following their descriptions is reviewed. It is concluded that the only essential diagnostic difference between the two is the tenderness that is associated with an Osler's node but not with a Janeway's lesion.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/7. Overwhelming postsplenectomy infection in a patient with penicillin-resistant streptococcus pneumoniae.Overwhelming postsplenectomy infection is a fulminant process that carries a poor prognosis. streptococcus pneumoniae is the most likely organism to cause disease. infection with penicillin-resistant S pneumoniae is increasing; its prevalence ranges from 6.6% to 50% in the united states. If meningeal involvement with resistant pneumococcus is suspected, it should be treated with a third-generation cephalosporin and vancomycin hydrochloride. The long-term management of asplenic patients should focus on preventing infection. The current guidelines and recommendations for vaccination are reviewed. Educating these patients to contact their physician at the first sign of minor illness is also beneficial. The use of antibiotic prophylaxis remains a controversy and is best left to the discretion of the physician.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |